By Richard Cramer
Healthcare delivery in the United States is high cost and suffers from inconsistent quality. A primary cause of these issues has been the reliance on antiquated, paper-based clinical records. These paper records have been an enormous barrier to high quality care -- making it virtually impossible to deliver coordinated care, locking away in paper data needed to analyze what works and doesn't in healthcare. For years lack of available data structured a system that pays for activity, rather than results. Now with the introduction of Electronic Healthcare Records (EHR), technology has stepped in to lead healthcare reform.
Beginning of change
In 2009, the Health Information Technology for Economic and Clinical Health Act was signed into law -- promoting adoption and meaningful use of health information technology. Thanks to Centers for Medicare & Medicaid Services Incentive Programs, "meaningful use" standards made EHRs key to measuring quality care (aka "results"). For the first time, providers had an incentive to document care using electronic data, capturing information to could be analyzed to establish quality care standards. Clearly, the healthcare system is undergoing a shift towards relying on data to deliver higher value care. EHR technology signals a new era where data tracks treatment, results and even prevents negative care.
I've been in the healthcare industry for more than 18 years -- it's exciting to be in the middle of healthcare's technological revolution. With EHRs igniting reform, special attention needs to fall on the creation, archiving and reliability of data. To this end, two core data technologies shape the creation of EHRs: data integration and data quality. Without these technologies EHRs risk generating large volumes of data that cannot be effectively utilized to make clinical or business decisions.
Bridging the information gap
For years providers have tracked patients' medical history and care using paper charts. These charts are location dependent, leaving each hospital and each provider with their own view of the patient. The picture of the patient therefore depended on the individual chart -- susceptible any number of liabilities the least of which, ineligible penmanship. There was little that technology could do to help highlight key pieces of information, identify information gaps, or ensure the best decisions because the information was not data -- it was words on paper. EHRs completely change this dynamic by allowing automated techniques to draw attention to critical data, apply clinical rules to assist decision making, and countless value-added insights. EHRs paper's most vexing issue -- data is accessible in multiple locations. For the first time a consolidated medical record for an individual patient spans offices, hospitals and care settings.
The fact EHRs makes sharing data possible does not translate to easy, straightforward or widespread adoption. Much like individual organizations created their own paper chart out of necessity; they have approach EHRs in a similar manner. As a result, many hospital organizations have one EHR for their ambulatory practices, a separate system for the hospital, and any number of other EHRs used by affiliated, and private facilities that share the same patient population.
Data integration is a technology that assists in making EHR data useful. It addresses the challenges of bringing together data from disparate systems, ensuring a holistic pool of data across different systems that can be leveraged to for analysis to derive insights that improve care.
Quality over quantity
EHRs are generating a wealth of information and simply having data in an EHR does not solve the data fragmentation problem. Merging the data together is just the first step, data quality is the next. It ensures medical professionals have the right data to make the right decisions.
For example, Jane Smith begins has an existing medical record. She gets married and becomes Jane Jones. The next time she visits the doctor, she fills out an intake form under Jane Jones. When her data is entered into the system, sophisticated matching is able to identify her as the same Jane Smith with an existing record by looking beyond just name, to include age, addresses, phone and other data while also allowing for entry errors. The same Jane Jones could move following her marriage and data quality factors like height, gender etc. can be leveraged to identify records that need to be merged together, eliminating the risk of missed patient history that might be critically important to a current diagnosis.
Promising future for data
Leveraging holistic and reliable data can realize the promise of EHRs -- consistent, high-quality, efficient and cost-effective care. But for this potential to be realized, we first need to do the pragmatic, hard, pick-and-shovel work of ensuring that patients are uniquely identified, and the data we know about them is accurate, timely and trustworthy. Data integration and data quality technologies are the key elements to unlocking the potential of data captured in EHRs to revolutionize healthcare.
In 2003 the ten year project of mapping the human genome was completed, now ten years later researchers claim to do it in 4 hours. Imagine this technology merging with EHRs -- mapping entire individual medical histories for patients from genetics to current health. What type of insights or predictions could result from integrating these two data sources?
Technology in healthcare is sparking speculation of how new capabilities will intersect to predict future illnesses in patients, reveal secrets about our ancestry, or map a path of treatment -- the possibilities are endless.
And it all begins with data.
Richard Cramer is the Chief Healthcare Strategist for Informatica. He is responsible for working with Informatica's healthcare prospects and customers to understand their business and clinical objectives and ensuring Informatica's products and solutions meet the needs of the healthcare market.